Síndrome de ovario poliquístico: fenotipos y enfermedad cardiovascular / Polycystic ovary syndrome: Phenotypes and cardiovascular disease

Introducción: El síndrome de ovario poliquístico (SOP) es una endocrinopatía que afecta a mujeres en edad reproductiva, frecuentemente asociado a insulinorresistencia (IR) y riesgo cardiovascular (RCV). El criterio de Rotterdam distingue 4 fenotipos: 3 presentan hiperandrogenismo clínico y/o bioquímico (HA) y uno es normo-androgénico (NHA). Por ser un síndrome heterogéneo, es necesario identificar a las pacientes con mayor RCV. Dos nuevos marcadores han sido propuestos para evaluarlo: el índice de adiposidad abdominal (VAI) y el producto de acumulación lipídica (LAP). Objetivo: Evaluar los marcadores LAP y VAI como predictores de IR y su correlación con los parámetros de RCV en relación con los fenotipos SOP. Metodología: Se estudió a 130 pacientes con SOP entre 18 y 36 años, clasificadas en 2 grupos: HA y NHA según la presencia de hiperandrogenismo clínico y/o bioquímico. Se evaluaron parámetros de RCV según ATP III: circunferencia de cintura (CC), glucemia, HDL, triglicéridos (TG) y presión arterial. Se calcularon: LAP = (CC [cm] - 58) * TG (mmol/l) y VAI = (CC [cm]/[36,58 + (1,89 * IMC [kg/m²]] * [TG [mg/dl]/0,81] * [1,52/HDL-c [mg/dl]]). Se realizaron curvas ROC/área bajo la curva para establecer valores de corte de LAP y VAI para la identificación de IR, análisis de correlación con parámetros de RCV y de las diferencias entre fenotipos, tomando como significativo p < 0,05. Resultados: Los valores de corte establecidos para definir IR fueron de 14,02 para LAP (especificidad: 93,22%; sensibilidad: 93,94%) y de 2,17 para VAI (especificidad: 91,38%; sensibilidad: 87,88). Dichos marcadores correlacionaron con marcadores de IR (HOMA-IR, QUICKI e índice glucosa/insulina) y presentaron una correlación positiva con TG, CC y negativa con HDL. El análisis entre fenotipos no reveló diferencias en la presencia de SM, IR o factores de RCV. Conclusión: LAP y VAI serían buenos predictores de IR y RCV asociado en pacientes jóvenes con SOP. El análisis de los parámetros entre fenotipos HA y NHA indica que ambos presentan similar riesgo metabólico y de desarrollar enfermedad cardiovascular.

Introduction: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age. It is associated with insulin resistance (IR) and high cardiovascular risk (CVR). According to the Rotterdam consensus, four PCOS phenotypes could be established: three with clinical and/or biochemical hyperandrogenism (HA), and one non-hyperandrogenic (NHA). It is necessary to identify which of these patients are at risk of metabolic disturbances and CVR. Two indexes: lipid accumulation product (LAP) and visceral adiposity index (VAI) have been suggested as reliable markers of IR and CVR in PCOS. Objective: The present study aims to assess the reliability of LAP and VAI as IR markers in a young local population of PCOS patients. Their association with CVR parameters is also evaluated. Methodology: LAP and VAI were calculated in 130 PCOS patients. The PCOS patients were divided in two groups as HA and NHA, taking into account the signs of hyperandrogenism (clinical or biochemical). An evaluation was also made of the metabolic and anthropometric characteristics of the population and their association with CVR and IR. Results: Both LAP and VAI showed to be effective markers to asses CVR and IR in these PCOS women (cutoff values: LAP: 14.02 (sensitivity: 93.94% specificity: 93.22%) VAI: 2.17 (sensitivity: 87.88% specificity: 91.38%). There was a positive correlation of both markers with abdominal circumference and triglycerides (TG), and negative with HDL-cholesterol. The risk of IR and metabolic disturbances was similar in both phenotypes (NHA versus HA). Conclusion: Our data show that both LAP and VAI are representative markers for assessing IR and associated CVR in PCOS patients. These results also suggest that the NHA phenotype in the population studied shows the same risk of metabolic disturbances and cardiovascular disease when compared to HA phenotypes.

Seudoaneurisma de la arteria mesentérica superior tras duodenopancreatectomía cefálica / Pseudoaneurysm of the superior mesenteric artery after pancreatoduodenectomy

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Low dose of bisphenol A impairs the reproductive axis of prepuberal male rats

The objective of the present work was to study the effect of a low dose of bisphenol A (BPA), on the reproductive axis of prepuberal male rats exposed to the endocrine disruptor (ED) during gestation and lactation period. Wistar-mated rats were treated with either 0.1 % ethanol or BPA in their drinking water until their offspring were weaned at the age of 21 days. The estimated average dose of exposure to dams was approximately 3 ìg/kg/day of BPA. The pups were sacrificed on the 35th day of life. Body weight was measured during the development and at the moment of the sacrifice; testicular and seminal vesicles weight and their respective relative weights were also measured. LH, FSH and testosterone were determined and histological studies of testicular tissue were also performed. Body weight at the moment of the sacrifice was significantly higher in the group exposed to BPA; testicular weight decreased significantly; seminal vesicles weight and relative weights of testes and seminal vesicles were not modified by treatment. LH and FSH serum levels increased significantly after treatment, meanwhile testosterone showed no significant changes. Histological studies showed the lumen of seminal tubes reduced by the presence of immature cells of the spermatic lineage. Our results suggest that pre- and early postnatal exposure to a low dose of BPA disrupts the normal function of the reproductive axis in prepuberal male rats. The effects of the ED may be exerted at different levels of the axis and may be dependent on the dose, manner of administration, and the moment of exposure to the disruptor

Low dose of bisphenol A impairs the reproductive axis of prepuberal male rats.

The objective of the present work was to study the effect of a low dose of bisphenol A (BPA), on the reproductive axis of prepuberal male rats exposed to the endocrine disruptor (ED) during gestation and lactation period. Wistar-mated rats were treated with either 0.1 % ethanol or BPA in their drinking water until their offspring were weaned at the age of 21 days. The estimated average dose of exposure to dams was approximately 3 µg/kg/day of BPA. The pups were sacrificed on the 35th day of life. Body weight was measured during the development and at the moment of the sacrifice; testicular and seminal vesicles weight and their respective relative weights were also measured. LH, FSH and testosterone were determined and histological studies of testicular tissue were also performed. Body weight at the moment of the sacrifice was significantly higher in the group exposed to BPA; testicular weight decreased significantly; seminal vesicles weight and relative weights of testes and seminal vesicles were not modified by treatment. LH and FSH serum levels increased significantly after treatment, meanwhile testosterone showed no significant changes. Histological studies showed the lumen of seminal tubes reduced by the presence of immature cells of the spermatic lineage. Our results suggest that pre- and early postnatal exposure to a low dose of BPA disrupts the normal function of the reproductive axis in prepuberal male rats. The effects of the ED may be exerted at different levels of the axis and may be dependent on the dose, manner of administration, and the moment of exposure to the disruptor.